If you’ve ever seen your pediatric provider examine your baby, you many wonder why he spends time examining “down there.” What might he be looking for? And what could possibly be wrong? Aren’t we more concerned about genitalia when they’re older?
Actually, it’s the provider’s job to monitor the health of the infant’s entire body, and that includes the genitalia. If you have a male infant, your pediatric provider will take care to examine his penis, scrotum and testicles. Although in the majority of cases everything will turn out to be just fine, and there is a wide variety of normal, there are certain conditions that need addressing. Many just need to be observed for a period of time, but some do constitute true emergencies. Let’s look at some of the conditions affecting the scrotum—the sac that houses the testicles.
The Undescended Testicle
A boy’s testicles are actually formed in the abdomen. Shortly before birth, they descend into the scrotum. Very premature babies are more likely to have undescended testicles; however, in two to five perecent of term infants one or both testes will fail to descend properly. This phenomenon leads to cryptorchidism, which is essentially medical speak for undescended testicle.
Your newborn’s provider will examine the scrotum carefully to make sure that she can feel both testicles. If she can’t feel either one, she will likely refer to a specialist to make sure they are present (usually in the abdomen if not the scrotum) and that there is not an issue with the male hormones responsible for proper formation of the sex organs.
However, if just one is undescended, it’s more of a waiting game. Most testicles will descend on their own within a few months of birth. If after four to six months the provider can’t feel anything in the scrotum, however, he will likely refer to a urologist.
Why the urologist? What is the issue? It turns out that there are actually two problems that need to be avoided. First of all, there is a risk of decreased sperm formation which may affect fertility. This happens because sperm, which is formed in the testicles, need a slightly cooler temperature to form than normal body temperature—thus the need for them to be brought down from the abdomen into the scrotum.
Secondly, there is a slight increase in the risk of testicular cancer if the testis remains in the abdomen. (Even boys who have been successfully treated for an undescended testicle have some increase in risk, but it’s higher if they are untreated.)
The thinking on how and when to treat an undescended testicle has changed over the years. Formerly, there was a tendency to observe for a few years before treating. Also, hormonal treatments were sometimes used as an alternative to surgery. Nowadays, however, it’s recommended that a urology referral for the problem take place as early as four months of age, and hormonal treatments are used much less often.
Hydroceles and Hernias
Your young man’s provider will also examine the scrotum with other conditions in mind. One very common finding is known as a hydrocele. Best described as “fluid in the scrotum,” this is a common condition affecting up to one half of newborn boys. It occurs when there is an opening between the abdomen and the scrotum, causing the flow of fluid between the two areas.
Hydroceles by themselves don’t really cause problems; however, your provider will look for the presence of a hernia in that spot. A hernia occurs when the communication between the scrotum and abdomen is such that a piece of bowel can become trapped in the area. This needs to be repaired—urgently, if there is redness, swelling, tenderness, or the inability of your provider to push the bowel back into the abdomen. If none of these are happening, the hernia still needs to be fixed, but electively. (Incidentally, we are talking about an inguinal hernia here. Your doctor may have told you that your child has an umbilical hernia, which is very common, involves a different spot on the abdomen, and can usually be observed.)
If your boy has a hydrocele, but no hernia, it can usually be observed. Most will gradually get smaller and eventually disappear. If it’s still there by a year of age, your provider may recommend that it be corrected surgically.
Testicular Torsion: An Emergency
The scrotum may also hold clues to a rare but urgent problem known as testicular torsion. In this process, the cord that attached to the testicle twists. Since the testicle gets its blood supply through the cord, this supply is cut off, and the testicle may die if not treated quickly.
Although it’s more common in older boys, about 10 to 12 percent of pediatric torsions occur in newborns. Here the scrotum may give clues: there may be redness, tenderness or swelling. Since a newborn can’t always tell us what’s hurting, your provider may examine the baby’s scrotum if he is acting fussy or colicky, especially if the behavior is a sudden change.
If torsion is suspected, your provider will likely refer your boy immediately for testing (usually an ultrasound). From there, a urologist will make a decision on whether there is torsion that needs to be corrected surgically. Surgical correction is more likely to save the testicle if it is performed within a few hours of the torsion.